Ness David E
Mercy Hospital of Pittsburgh, Pittsburgh, PA , USA.
Arch Intern Med. 2002 Oct 14;162(18):2037-44. doi: 10.1001/archinte.162.18.2037.
Discussing medical treatment options and risks becomes a more complicated task when patients have psychiatric problems. Such patients may perceive risk and judge options differently from usual, they raise special issues about informed consent and competency, and they may present special needs and stresses in the physician-patient relationship. This article addresses how to approach such treatment discussions within the framework of 3 content areas of the medical interview (medical decision making, informed consent, and the physician-patient relationship) and 2 formal techniques of the interview (exploration and assertion). Clinical research regarding how psychiatric problems may affect each of these areas of concern is reviewed. Ultimately, the goal of understanding such variations--and of possessing methods to address them in discussing treatment options and risks--is to help the patient be as free as possible from the burden of biases or distortions in making his or her decisions and to promote the best fit between the patient's wishes and the physician's medical judgment.
当患者存在精神问题时，讨论医疗治疗方案和风险就会变成一项更为复杂的任务。这类患者对风险的认知和对方案的判断可能与常人不同，他们在知情同意和行为能力方面引发了特殊问题，并且在医患关系中可能呈现出特殊需求和压力。本文探讨了如何在医学问诊的三个内容领域（医疗决策、知情同意和医患关系）以及两种正式问诊技巧（探索和断言）的框架内进行此类治疗讨论。文中回顾了关于精神问题如何影响这些相关领域的临床研究。最终，理解这些差异并掌握在讨论治疗方案和风险时应对这些差异的方法，目的是帮助患者在做决定时尽可能摆脱偏见或扭曲的负担，并促进患者意愿与医生医疗判断之间的最佳契合。
